Introduction

Peritonitis caused by hollow viscous perforation continues to be one of the most challenging conditions confronted by a surgeon. It is one of the frequently encountered surgical emergencies in tropical countries like India and most of the times it affects young males in the productive phase of their life^1,2,3,4.  

Peritonitis following perforation of the gastrointestinal tract remains an important problem in the field of abdominal surgery. The clinical symptoms of peritonitis vary depending largely on the site of perforation as the contents and / or bacterial flora are not uniform throughout the gastrointestinal tract and thus the therapy for peritonitis should always been based on such facts. By now it has been established that the spectrum of etiology of perforation in Indian subcontinent differs from its western counterpart². Majority of the patients present late, with purulent peritonitis and septicemia⁵. Surgical treatment of perforation peritonitis is highly demanding and very complex, combination of improved surgical technique, anti microbial therapy and intensive care support has improved the outcome of such cases⁶.

Although, a number of advancements have been made in surgical techniques, antimicrobial therapy and intensive care support yet management of peritonitis continues to be highly demanding, difficult and complex. Consecutively, the prognosis of patients with perforation peritonitis and intra-abdominal infections is generally poor⁷.  Perforation peritonitis might be responsible for multi organ failure, thus increasing the severity of morbidity and mortality⁸.

Interestingly, there has been seen to be differences in the location of perforation in different geographical regions across the world. In eastern countries such as India and Pakistan, the proximal part of the gastrointestinal tract (GIT) is affected more commonly² whereas in western population distal gut perforation is more common. Overall, duodenum is the most common site of perforation⁹.

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Mushtaq Ali

Asst. Prof. Era Medical College, Sarfarazganj, Lucknow, India

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